C10003722 / invoice 20000

HISTORY:Presented on 08/03/2026 for acute onset of hindlimb wobbliness, restlessness, and discomfort. The owner reported Archie was wobbly on his back legs in the morning and was observed sitting on concrete, which is unusual behavior for him. Later in the day, he continued to choose to sit on the floor, was shaking, and whimpering. He was not observed to be hunched. He was sitting with his legs positioned slightly out in front of him. No previous episodes of this nature. No known prior orthopedic issues. Gait is described as normal with no skipping or holding up legs. Eating normally and passed faeces on the morning of presentation. Urination status was uncertain.Emergency vet examination on 08/03/2026 noted thoracolumbar spinal pain and mild hyperreflexia in the hindlimbs. Archie was admitted for overnight observation and pain relief. Methadone 0.2mg/kg q4hrs. Current medications: noneDiet: Less than half a scoop of kibble for breakfast and dinner. Occasional vegetable treats such as cucumber and carrots.Access to toxins: noneEXAMINATION:Subjective: BARBody Condition Score: 4/9Hydration: euhydratedObjective:Body weight: 6.1 kg (aim for under 6kg)HR: 96bpmRR: 32bpmTemp: 38.5Ears: AU no discharge, odor or other lesions of the external pinnae observed. Full otoscopic examination not performed.Eyes: OU normal, corneas transparent. No anisocoria, epiphora or blepharospasm noted. Normal menace and menaceNose: No nasal lesions or discharge. No epistaxis noted.Oral: No dental disease present. No oral ulcerations, lesions or foreign bodies observed.Throat: No cough elicited on palpation of the trachea. No palpable abnormalities or goitre.Integument: No ectoparasites, wounds or mass lesions identified on exam.Cardiovascular: No murmur or arrhythmias auscultated. MM moist, pink CRT 1 - 2secs. No skin tent. Femoral pulses are synchronous and strong. Peripheries warmRespiratory:Normal bronchovesicular lung sounds all four quadrants. No crackles or wheezes. No stertor/stridor.Peripheral Lymph Nodes: Submandibular, prescapular and popliteal LNs are within normal size limits <1cm.Abdominal: Soft and comfortable on abdominal palpation. No palpable organomegaly, mass effect or fluid wave.Rectal: Not performedUrogenital: External genitalia unremarkable. Desexed. Musculoskeletal: No spinal pain elicited today on examination. Repeatable pain on manipulation of the patellas, right hindlimb worse than left. Grade 1-2 medial patella luxation bilaterally. Difficult to displace; however, crepitus is palpable when the leg is moved from flexion to extension over the medial trochlear ridge.Neurological:Mentation appropriate. Mild ataxia noted, possibly confounded by genus varus deformity common in the breed. Conscious proprioception is normal. Patella reflexes are normal bilaterally. Slightly slow hopping on the right hindlimb, left hindlimb is normal.DIAGNOSTICS:PCV/TP 58/60  GLU 6.71 mmol/L 4.11 - 7.95 				 CREA 57 µmol/L 44 - 159 							 UREA 3.0 mmol/L 2.5 - 9.6 							 BUN/CREA 13  TP 62 g/L 52 - 82 								 ALB 36 g/L 23 - 40 								 GLOB 26 g/L 25 - 45 								 ALB/GLOB 1.4  ALT 55 U/L 10 - 125 								 ALKP 25 U/L 23 - 212 								 Na 154 mmol/L 144 - 160 								 K 4.2 mmol/L 3.5 - 5.8 								 Na/K 37  Cl 119 mmol/L 109 - 122 								 Osm Calc 304 mmol/kgPROBLEM LIST:- Acute onset ataxia/paresis (improved)- Thoracolumbar spinal pain (resolved)- Bilateral medial patella luxation (Grade 1-2) with associated pain- Mildly overweightASSESSMENT:1. Suspected Intervertebral Disc Disease (IVDD)- Likely diagnosis is grade 1-2 IVDD, given breed, history, and clinical signs which have improved with rest and initial pain relief. Neurological status is stable to improved since admission. No spinal pain elicited on examination today.- Differential diagnoses include other causes of spinal pain or neurological deficits.- Recommended diagnostic tests: Advanced imaging (CT/MRI) was discussed but deferred as the patient is clinically improving. Imaging would be recommended if signs worsen or fail to resolve with conservative management.- Treatment plan: Conservative management with strict rest for 6-8 weeks and anti-inflammatory medication.- Follow-up care: Re-check in 1 week. Owners advised to monitor for any deterioration such as recurrence of pain, increased wobbliness, or inability to walk.2. Bilateral Medial Patella Luxation (MPL)- Assessment: Grade 1-2 MPL, right worse than left, with associated pain on manipulation. This is likely a separate, chronic issue exacerbated by current presentation or identified incidentally.- Recommended diagnostic tests: Radiographs of the stifles were discussed to assess conformation but deferred. To be considered if lameness or pain persists despite medical management.- Treatment plan: Trial of anti-inflammatory medication as part of the IVDD management.- Follow-up care: Re-assess at the 1-week re-check. Surgical options may be considered if clinical signs persist or worsen.3. Mildly Overweight- Assessment: Current weight is 6.1 kg. Previous weight was 6.6 kg.- Treatment plan: Weight loss is recommended. Target weight of 6.0 kg or slightly less. This will help manage both spinal and joint issues.- Follow-up care: Monitor weight at re-checks.Options Offered to Client for Ongoing Care:1. Advanced imaging (CT/MRI) and potential surgery: Discussed to obtain a definitive diagnosis for spinal condition. Owners declined at this stage due to clinical improvement and associated risks/invasiveness.2. Conservative medical management: Strict rest, pain relief, and close monitoring. Owners elected for this option.3. Follow-up with primary vet: Owners elected to have ongoing management and re-checks performed at their primary vet, Greencross Vets AlexandriaTREATMENT PLAN:Discharge home for outpatient management.- Strict rest for 6-8 weeks. Confined to a small area (e.g., playpen approx. 1x1.5m). No running, jumping, or playing. Short, leashed toilet walks only (5-10 minutes).- Gabapentin: For neuropathic pain and sedation. 100mg BID PO- Anti-inflammatory medication: Meloxicam 0.1mg/kg PO for 5 - 7 days PO- Re-check examination in 1 week at their primary vet.- Gradual weight reduction towards a target of 6.0 kg.Comments:Handover provided to Greencross Vets regarding Archie's case and the ongoing management plan.CLIENT COMMUNICATION:Discussed the high suspicion of IVDD (Grade 1-2) and the separate issue of bilateral MPL. Explained the pathophysiology of IVDD in dachshunds and the grading system. Advised that Archie is currently improving and conservative management is the recommended course of action. 80% recovery with conservative management vs 90 - 95% with surgery. The risks of surgery making him worse were also discussed. Strict rest for 6-8 weeks is crucial to prevent re-extrusion of disc material and allow for healing. Correct handling techniques (keeping spine parallel to the ground) were demonstrated. Advised to monitor for signs of deterioration, including recurrence of pain (whimpering, restlessness, shivering not related to cold), wobbliness, or inability to move legs, and to seek immediate veterinary attention if these occur. If there is no improvement within 2 weeks, further investigation will be required. The owner consented to conservative management and discharge. The plan for follow-up with their primary vet was confirmed.    Vital Signs    

Reason: Loss In Coordination, Shaking In Pain, Firm AbdomeAppointment Notes: Overdue remindersHISTORY:  Presented for acute onset of wobbliness in the hindlimbs, restlessness, and discomfort, which started today. The owner reports that Archie is eating normally and has passed faeces this morning. Urination status today is uncertain. Otherwise healthy.Current meds: noneExamination Findings:  Temperament: BAR and friendly but a little nervousHydration:  EuhydratedEyes/ears/nose: No significant findingsOral Cavity: No significant findingsLymphatic: No peripheral lymphadenopathyCardiovascular: Normal heart rate, sinus rhythm, no murmurs. Moderate and synchronous pulses bilaterally.MM color pinkCRT: CRT <2Respiratory: Normal respiratory rate and effort.  Auscultation of lungs - No significant findings.Abdominal: Soft and nonpainful. No palpable masses, organomegaly or fluid wave notedMusculoskeletal: Ambulatory x 4 with no apparent pain, lameness or joint effusion. Normal muscle mass and tone. Back pain.BCS: 4/9Urogenital: No significant findingsIntegumentary: No significant findingsNeurological: Normal neurologic exam with normal mentation.  No proprioceptive deficits or overt ataxia; mild hyperreflexia noted hind limbs; full neuro exam not performed. Rectal: Not examinedPROBLEM LIST:- Acute onset ataxia/paresis- Thoracolumbar spinal pain- Restlessness- Suspected hyperreflexia hind limbs DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Suspected intervertebral disc disease (IVDD) given breed and clinical signs.  CLIENT COMMUNICATION:A detailed discussion was had with the owners regarding the suspicion of IVDD, the typical disease process in dachshunds, and the potential for clinical progression. The options of at-home medical management (strict rest, pain relief) versus hospitalisation for monitoring and specialist referral were presented. The benefits and risks of advanced imaging (MRI) for a definitive diagnosis were explained, including the need for general anaesthesia and the associated risks, which are considered low for Archie. The estimated cost for an MRI was discussed (approx. $6,000-$8,000). The owners' insurance coverage, including specific IVDD cover, was discussed. Becuase it's sunday evening, they were unable to confirm cover. The plan to admit Archie for overnight observation and specialist referral was agreed upon. An estimate for overnight care, including monitoring, pain relief, bloods, and the specialist referral fee, was provided (approx. $1,000). The owners were advised that no news overnight is good news and that they will be contacted immediately if there are any concerns. They can call for an update at any time. They were also informed that the specialist team would call them tomorrow morning after their rounds and patient assessment. No MRI will be performed without first speaking with owner and confirming plan and insurance cover.DIAGNOSTICS:Pending: pre-GA/NSAID panelPLAN:Hospitalization in ICU for monitoringMethadone 0.25mg/kg IM or SC q 4hrs PRNGabapentin 100mg PO q12hrs PRNOffer food- ate well; then NPO overnightInternal referral to Surgery tomorrow.Referral Vet Communication: --- 08/03/2026 22:22:16 SLH: records sent    Vital Signs    Weight: 6.2;       MMColour: pink;       Temperature: 38.9;       HeartRate: 150;       RespirationRate: normal;       CRT: <2;